197494358-10-2-2019-30-CC-CESO-BGKS6Z-20191002133646

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197494358
Report Date: 10/02/2019
Date Signed: 10/02/2019 01:37:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME:	MAMREYAN FAMILY CHILD CARE		FACILITY NUMBER:	197494358
ADMINISTRATOR:	MAMREYAN, ZHANNA		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(818) 859-0080
CITY:	BURBANK	STATE: CA	ZIP CODE:	91506
CAPACITY:	14	CENSUS: 0	DATE:	10/02/2019
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Zhanna Mamreyan		TIME COMPLETED:	01:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPAs) Stella Gutierrez, Claudia Escobedo and Licensing Program Manager Victor Bautista conducted an announced Pre-Licensing Inspection at the facility to ensure that health and safety standards will be met as required by regulations, statutes, and requirements governing California Family Child Care homes. This is an application for 14 children, however, with further analysis of the application, a Small Family Child Care License is being considered due to Title 22 regulations, as applicant has no prior experience as a licensed Family Child Care provider. Applicant agrees to the reduction of licensing capacity to 8 children. Upon arrival, LPAs Gutierrez and Escobedo and LPM Bautista met with Applicant Zhanna Mamreyan and her daughter, Jaklin Khodabakhshian and explained the purpose of the inspection. LPAs and LPM were guided on a tour of the home, indoors and outdoors. Per facility sketch and tour of the home, the following was observed and discussed with the Applicant during the inspection: Home is a 1 story dwelling with an independent dwelling in the back (Address 1030 ½ Parish Place, Burbank, 91506). The resident of this independent dwelling does not have access to the children in care. The home consists of two bedrooms, one living room, one dining room, one den, 1 ½ bathrooms, a driveway on the south side of the home leading to a detached and locked garage (used as a laundry room) and an inaccessible passageway (blocked by a safety gate) located on the north side of the home. LPAs observed the following when the entering the front door (with an auditory alarm when opening door): · Playroom #1 on the right hand side with a ½ bathroom with one working toilet and working sink. The playroom includes a walk-in closet that is inaccessible to the children via a child-proof doorknob, one working carbon monoxide/smoke detector (dual), 2 windows with blinds. Continued on Page 2

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MAMREYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494358
	VISIT DATE: 10/02/2019

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Playroom #2-on the left hand side with an accessible sliding door closet, one full-view window and two small windows, sliding glass doors lead to an accessible dining room. There is a dual smoke detector/carbon monoxide alarm. This room will be used as a play/activity room and napping. Latch locks were observed over two doors, which were removed during the inspection.
Living-room is equipped with a dual carbon monoxide/smoke detector. This room will be used when viewing television.
Dining Area-will be used as the children’s eating area
One full bathroom (off limits) made inaccessible by child safety knob is located to the right of the living room
One bedroom (off limits) is not yet inaccessible to the children. Applicant has a cat, which will be housed in this bedroom during hours of child care.

· 1 kitchen (off limits) made inaccessible by a safety gate has a working refrigerator. Cabinets have latches and or locks. A knife was observed and is made inaccessible to children by being placed in a top tier cabinet. Kitchen has a backroom which is inaccessible by a safety gate with a working fire extinguisher (1A 10 BC) with a receipt dated 7/30/2019. First-aid kit was observed in this area. 1 container of medications in a latched cabinet was observed and relocated to the locked detached garage.
· 1 front yard which is on limits as children enter the home. The front yard will not be used as a play area.
· 1 backyard is accessed through the dining room sliding glass doors and stairs leading to play area. There is green turf and one tree. The backyard has a 3 foot high linked child safety fence which can be expanded.

The following was also observed by LPAs during the inspection
1. Two adults living in the home have submitted fingerprints and child abuse index check forms to Department of Justice. Criminial Record Clearance to be associated to facility for applicant.
2. Home is neat and clean.
3. Central air and heat is available.

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SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

Page: 2 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MAMREYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494358
	VISIT DATE: 10/02/2019

NARRATIVE

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4. Home is equipped with a fully charged fire extinguisher a 4A:60BC. The fire extinguisher is not yet secured to the wall. Applicant will consult with the fire department to determine an appropriate and safe manner to store.

5. Home is equipped with working smoke alarm and carbon monoxide detectors that are interconnected and will sound off in succession of each other.

6. Home has a working telephone located in the back kitchen.
7. In the laundry room, backroom kitchen and off-limits bathroom, poisons (detergents, cleaning compounds, medications were made inaccessible to children.
8. Hazardous materials are kept out of the reach of children (inaccessible)
9. According to the applicant, there are no weapons or firearms at the home. None were observed by the LPAs.
10. Outdoor play area is not free from defects or dangerous conditions. The outdoor play area is accessed through the dining room sliding doors and five stairs with green turf, which makes it difficult with perception of depth. LPAs observed a protruding nail, counter-top that is covered with rubber matting which is easily removable, a large sink, accessible pebbles and rocks, sharp strap to the water heater, and chipped paint on the exterior of the neighbor’s building which is accessible to the children. Outdoor play area is fenced in by a 3 foot high linked child safety fence.
11. No bodies of water were observed during the inspection.
12. Toys and play items are safe, clean, and appropriate for the age of the children.
13. . LPAs observed 2 cots for napping.
14. Applicant agrees that no baby walkers, bouncers, jumpers, and similar items will be used for children in care and are kept inaccessible. LPAs observed a bouncer which was removed from the home during today’s inspection.
15. The home is equipped with a first aid kit and thermometer located in back room of kitchen.

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SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MAMREYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494358
	VISIT DATE: 10/02/2019

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The following was discussed with the applicant:
Incidental Medical Services (IMS) policy was discussed. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm Incidental Medical Services Include: Blood-Glucose Monitoring for Diabetic Children, Administering Inhaled Medication, Administering EpiPen Jr. and EpiPen or other Epinephrine Auto-Injectors, Glucagon Administration, Gastrostomy Tube Care (G-tube care), Insulin Injections Administration, Anti-Seizure Administration, and Carrying out medical orders when the child’s physician has determined that a layperson can be trained and safely carry out the orders.

Applicant was made aware of The Child Care Advocate Program (CCAP) that is administered from within the Community Care Licensing Division. CCAP participates in many community activities and special projects in order to disseminate information on the State’s licensing role, provide information to the public and parents on child care licensing, and provide many other helpful resources to the licensees and the public. CCAP’s direct contact information is as followed: Phone number: (916) 654-1541

Email Address: childcareadvocatesprogram@dss.ca.gov

Commencing September 1, 2016, SB 792, prohibits a person from being employed or volunteering at a child care facility or family day care if he or she has not been immunized against influenza, pertussis and measles. LPA discussed the influenza waiver during the inspection.

Beginning on January 1, 2018, AB 1207, requires all licensed providers, applicants, directors and employees to complete training as specified on their mandated reporter duties and to renew their training every two years. Volunteers are encouraged but not required to take the training. Website: www.mandatedreporterca.com. Licensee was reminded of their responsibility to report suspected child abuse.

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SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

Page: 4 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MAMREYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494358
	VISIT DATE: 10/02/2019

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Mandatory Forms for the children’s files and provider’s files were discussed. Licensee was referred to LIC 311D: Records To Be Maintained At The Facility - Family Child Care Home. Licensee was advised that regulation prohibits the smoking of tobacco in a private residence licensed as a family child care home during the hours of operation. Licensee was made aware that state law prohibits baby walkers, bouncy seats, exersaucers and any other items that fall into that category. Licensee was reminded that all infants must be placed on their backs when sleeping to prevent S.I.D.S. (Sudden Infant Death Syndrome), and that the Provider is required to wash hands after every diaper change and to never shake a baby to prevent the Shaken Baby Syndrome.

Reporting requirements were discussed: Applicant must report an incident to the Child Care Regional office by telephone within 24 hours and in writing within 7 days.

Applicant was also reminded that only children eating may be in high chairs and that car seats are utilized only for transportation.

Applicant was reminded that it is the licensee’s, as well as anyone who assists in providing care responsibility to know the regulations. Applicant was advised on how to access quarterly reports, forms, and regulations for Child Care online at www.ccld.ca.gov. Licensee was also encouraged to read the Child Care quarterly updates every season as they come out to stay informed of any changes or updates to statutes and regulations.

AAP: https://www.healthychildren.org/English/ages-stages/baby/sleep/Pages/A-Parents-Guide-to-Safe-Sleep.aspx

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SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

Page: 5 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 300 CONTINENTAL BLVD. STE 290A
EL SEGUNDO, CA 90245

FACILITY NAME: MAMREYAN FAMILY CHILD CARE	FACILITY NUMBER: 197494358
	VISIT DATE: 10/02/2019

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NIH: https://safetosleep.nichd.nih.gov/safesleepbasics/environment/room/text_alternative Safe to Sleep Campaign: https://safetosleep.nichd.nih.gov/materials 19-02 CCP Safe Sleep Awareness Campaign

Proof of corrections have been discussed with Applicant, including:

· Bedroom #2 door to be made inaccessible to children

· Poisons, including detergents, cleaning compounds, medications to be made inaccessible to children (Medications were made inaccessible by being placed in off-limits locked garage)
· Protruding nail to be removed or flushed against wall-(Nail was hammered in and flushed against wall)
· Pebbles and rocks to be covered or removed (This area was covered with artifical turf)
· Strap to water heater to be covered or removed
· Stairs leading to backyard to be striped
· Glass and screen doors leading to backyard to be made easily visible to children with a sign (Signs were placed on glass doors and screen)
· Chipped paint on the exterior of the building and window sill to be removed and repainted
· Counter top to be made inaccessible to children by extending the 3 foot high linked security gate
· Windows need to be screened
· Latch above two doors in Playroom #2 to be removed (Latches were removed)
· Bouncer needs to be removed from the home (Bouncer was placed in the trash)
· Broken glass to be removed from side of garage (Glass was removed)
· The fire extinguisher is not yet secured to the wall. Applicant will consult with the fire department to determine an appropriate and safe manner to store.
An exit interview was conducted with the above items discussed and a copy of this report was provided to the applicant. Final license determination will be made upon review by the Licensing Program Manager and correction of the above issues . Applicant to correct items by 10/7/2019. If available an Armenian LPA to be assigned.

SUPERVISOR'S NAME: Victor Bautista	TELEPHONE: (424) 301-3008
LICENSING EVALUATOR NAME: Claudia Escobedo	TELEPHONE: (424) 301-3044
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2019

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2019

LIC809 (FAS) - (06/04)

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